<!DOCTYPE html>
<html>
<head>
    <meta charset="UTF-8">

    <style>
        .main-container {
            font-family: SF-UI-Text-Regular;
            width: 17cm;
            margin: 0 auto;
            padding: 20px;
            background-color: #D3D3D3;
        }

        .float-left {
            float: left;
        }

        .float-right {
            float: right;
        }

        .padding-left-right {
            padding-left: 20px;
            padding-right: 20px;
        }

        .margin-left-right {
            margin-left: 20px;
            margin-right: 20px;
        }

        .section {
            /*border: 3px dashed #CCC;*/
            /*padding: 20px;*/
            border-Top: 2px dashed #D3D3D3;
            padding-Top: 13px;
            margin-bottom: 16px;
            margin-Top: 20px;
        }

        .section-details p {
            color: #126089;
            /*font-size: 16px;*/
        }

        .grouper {
            overflow: hidden;
        }

        .grid-50 {
            width: 50%;
        }

        .grid-70 {
            width: 70%;
        }

        .grid-30 {
            width: 30%;
        }

        @font-face {
            font-family: 'SF-UI-Text-Regular';
            src: url("https://s3-ap-southeast-1.amazonaws.com/content.staging.whitecoat.global/PDF/Templates/fonts/SF-UI-Text-Regular.otf");
            font-style: normal;
        }

        h1 {
            font-size: 22px;
            font-family: 'SF-UI-Text-Regular';
        }

        .h1-main {
            margin-top: 90px;
        }

        p {
            margin: 0 0 10px 0;
            font-family: 'SF-UI-Text-Regular';
            font-size: 20px;
        }

        .p-spec {
            color: #149a9a;
            font-weight: bold;
        }


        .margin-b-30 {
            margin-bottom: 30px;
        }

    </style>
</head>
<body>

<div class="main-container">
    <div style="display:${data.visible!};margin-bottom: 10px">
        <p style='font-weight: bold'>${data.partnershipWithText!}</p>
        <img style="max-width:250px;max-height: 150px;margin-bottom: 13px"
             src="https://s3-ap-southeast-1.amazonaws.com/content.staging.whitecoat.global/PDF/Templates/Images/logo_whitecoat_v2.png">
    </div>
    <div style="background-color: #fff">
        <div class="main-header grouper padding-left-right" style="padding-top: 20px">

            <div class="grouper margin-b-30">
                <!-- <img src="https://s3-ap-southeast-1.amazonaws.com/content.staging.whitecoat.global/PDF/Templates/Images/logo_whitecoat_v2.png" class="float-left">		 -->
                <img style="max-width:250px;max-height: 150px;margin-bottom: 13px" src="${data.doctorClinicLogo!}"
                     width="" class="float-left">
                <div class="float-right">
                    <p align="right" style="color:gray;"><strong>${data.receiptDateStr!}</strong></p>
                    <p align="right" style="color:gray;"><strong>${data.receiptNo!}</strong></p>
                    <div style="display:${data.visibleForSingapore!};">
                        <p align="right" style="color:gray;display:${data.visibleGSTRegNo!};"><strong>GST Reg.
                                No.:${data.GSTRegNoValue!}</strong></p>
                        <p align="right" style="color:gray;display:${data.visibleClinicLicenceNo!};">
                            <strong>${data.clinicLicenceNoText!}:</strong></p>
                        <p align="right" style="color:gray;display:${data.visibleClinicLicenceNo!};">
                            <strong>${data.clinicLicenceNoValue!}</strong></p>
                    </div>
                    <div style="display:${data.visibleForIndonesia!};">
                        <p align="right" style="color:gray;"><strong>GoApotik
                                Ref.:${data.goApotikReceiptNumber!}</strong></p>
                    </div>
                </div>
            </div>
        </div>

        <div class="main-body">

            <div class="grouper">

                <div class="grouper padding-left-right">

                    <div class="grid-30 float-left" style="margin-right: 15px;">
                        <P>${data.idNoText!}:</P>
                        <P>${data.nameText!}:</P>
                        <P>${data.visitDateText!}:</P>
                        <P style="display:${data.diagnosisForIndo!};">${data.diagnosisText!}:</P>
                    </div>

                    <div style="display:table;vertical-align: top">
                        <P><strong>${data.idNo!}</strong></P>
                        <P><strong>${data.name!}</strong></P>
                        <P><strong>${data.visitDateStr!}</strong></P>
                        <P style="display:${data.diagnosisForIndo!};"><strong>${data.diagnosis!}</strong></P>
                    </div>

                </div>


                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :0px;display:${data.visibleCountryRemark!}">
                    <div style="text-align:left;"><p>${data.countryRemarkValue!}</p></div>
                </div>


                <#--				consultaiton -->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;">
                    <div>
                        <div class="grid-50 float-left">
                            <P><strong>${data.consultationFeeText1!}</strong></P>
                            <P>${data.consultationFeeText2!}</P>
                            <P style="color:gray;">${data.consultationFeeText3!}</P>
                            <P style="display: ${data.visiblePromotionFee!}">${data.promoName!}</P>
                            <P><strong>${data.consultationSubTotalText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right">
                            <P style="text-align: right;">&nbsp;</P>
                            <P style="text-align: right;">$${data.consultationFee!}</P>
                            <P style="text-align: right;">&nbsp;</P>
                            <P style="text-align: right; display: ${data.visiblePromotionFee!}">${data.promoFee!}</P>
                            <P style="text-align: right;">$${data.consultationSubtotalValue!}</P>
                        </div>
                    </div>
                </div>

                <#--				delivery-->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visibleDeliveryFee!};">
                    <div>
                        <div class="grid-50 float-left">
                            <P><strong>${data.deliveryChargeText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right">
                            <P style="text-align: right;">$${data.deliveryFee!}</P>
                        </div>
                    </div>
                </div>


                <#--medicationsList -->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visibleMedicationFee!} ;">
                    <div>
                        <div class="grid-50 float-left" style="text-align: left;">
                            <P><strong>${data.medicationsListText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right" style="text-align: right;">
                            <P style="text-align: right;">&nbsp;</P>
                        </div>

                        <#if data.medicationsFeeList?has_content>
                            <#list data.medicationsFeeList as item>
                                <div class="grid-50 float-left" style="text-align: left;">
                                    <P><strong>${item.productName!}</strong></P>
                                    <P>${item.quantityText!}:${item.quantity!}</P>
                                </div>
                                <div class="grid-50 float-right" style="text-align: right;">
                                    <P>$${item.price!}</P>
                                    <P>&nbsp;</P>
                                </div>
                            </#list>
                        </#if>

                        <div class="grid-50 float-left" style="text-align: left;">
                            <P><strong>${data.medicationSubtotalText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right" style="text-align: right;">
                            <P style="text-align: right;">$${data.medicationSubtotalValue!}</P>
                        </div>
                    </div>
                </div>


                <#--medicalService List -->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visibleMedicalService!} ;">
                    <div>
                        <div class="grid-50 float-left" style="text-align: left;">
                            <P><strong>${data.medicalServiceText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right" style="text-align: right;">
                            <P style="text-align: right;">&nbsp;</P>
                        </div>

                        <#if data.medicalServiceFeeList?has_content>
                            <#list data.medicalServiceFeeList as item>
                                <div class="grid-50 float-left" style="text-align: left;">
                                    <P><strong>${item.medicalServiceName!}</strong></P>
                                    <P>${item.supplierName!}</P>
                                </div>
                            </#list>
                        </#if>

                        <div class="grid-50 float-left" style="text-align: left;">
                            <P><strong>${data.medicalServiceSubtotalText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right" style="text-align: right;">
                            <P style="text-align: right;">$${data.medicalServiceSubtotalValue!}</P>
                        </div>
                    </div>
                </div>


                <#--cdmp fee list -->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visibleCDMPFee!} ;">
                    <div>
                        <div class="grid-50 float-left" style="text-align: left;">
                            <P><strong>${data.CDMPBenefitName!}</strong></P>
                        </div>
                        <div class="grid-50 float-right" style="text-align: right;">
                            <P style="text-align: right;">$${data.cdmpFee!}</P>
                        </div>
                        <#if data.CDMPFeeList?has_content>
                            <#list data.CDMPFeeList as item>
                                <div class="grid-50 float-left" style="text-align: left;">
                                    <P>-${item.conditionName!}</P>
                                </div>
                            </#list>
                        </#if>
                    </div>
                </div>


                <#--practice charge-->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visiblePracticeFee!};">
                    <div>
                        <div class="grid-50 float-left">
                            <P><strong>${data.practiceChargeText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right">
                            <P style="text-align: right;">$${data.practiceFee!}</P>
                        </div>
                    </div>
                </div>


                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visibleBlockTotal!};">
                    <div>
                        <div class="grid-50 float-left">
                            <P><strong>${data.totalExclGSTText!}</strong></P>
                            <P><strong>${data.GSTText!}</strong></P>
                            <P><strong>${data.totalInclGSTText!}</strong></P>
                        </div>
                        <div class="grid-50 float-right">
                            <P style="text-align: right;">$${data.totalValueExclGst!}</P>
                            <P style="text-align: right;">$${data.GST!}</P>
                            <P style="text-align: right;">$${data.totalValueInclGST!}</P>
                        </div>
                    </div>
                </div>

<#--                AIA Insurance-->
                <div class="grouper margin-left-right"
                     style="border-Top: 2px dashed #D3D3D3;margin-top:30px;padding-top:20px; padding-bottom :20px;display:${data.visibleAIA!};">
                    <div>
                        <div class="grid-50 float-left">
                            <P><strong>${data.benefitName!}</strong></P>
                            <P><strong>${data.copayText!}</strong> Payable</P>
                            <P><strong>${data.excessText!}</strong> Payable</P>
                        </div>
                        <div class="grid-50 float-right">
                            <P style="text-align: right;">$(${data.benefits!})</P>
                            <P style="text-align: right;">$${data.coPay!}</P>
                            <P style="text-align: right;">$${data.excess!}</P>
                        </div>
                    </div>
                </div>

                <div class="grouper padding-left-right"
                     style="padding-top:20px; padding-bottom :20px; background-color: #F0F0F0">
                    <div>
                        <div class="grid-50 float-left">

                            <P><strong>Grand Total (Incl. GST)</strong></P>
                            ${data.endingCardNo!}
                        </div>
                        <div class="grid-50 float-right">
                            <P style="text-align: right;">${data.grandValueInclGST!}</P>
                        </div>
                    </div>
                </div>
                <div class="grouper margin-left-right"
                     style="margin-top:2px;padding-top:20px; padding-bottom :20px;display:${data.visibleTextbasedCorporateName!};">
                    <div>
                        <div class="float-left"><P>${data.textbasedCorporateName!}</P></div>
                    </div>
                </div>

                ${data.logTransaction!}

            </div>


        </div>
    </div>
    <div style="padding: 20px 0 0 20px;color: #696969">${data.noteUniqueTransactionCode!}</div>
    <div style="padding: 20px 0 0 20px;color: #696969">${data.doctorClinicAddress!}</div>
    <div style="padding: 20px 0 0 20px;color: #696969;display:${data.supportVNEmail!};">
        <i>${data.supportVNEmailContent!}</i></div>
    <div style="padding: 20px 0 0 20px;color: #696969;display:${data.visiblePharmacyAddress!};">201 Henderson Road |
        Apex @ Henderson | #05-11/12 | Singapore 159545 | T: +65 6909 6609 | F: +65 6909 6606 | E:
        contactus@whitecoat.global
    </div>
</div>

</body>
</html>